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I put her in the category of Greek tragedy. After you do therapy for a while, you get a sense of a singular place called “Grim Future;” and a person, admirable in many ways, whose tragic flaw will take her there. Usually, you only witness the first few acts of the drama.

But you are certain, even though the data say therapists are flawed predictors.

These are the patients with whom you are powerless. Not a good thing for a peculiar profession, one hoping to prevent disaster, enable happiness.

She was a university student. Her parents actually did the leg-work to find a therapist to “fix” her. I came recommended, though an odd choice for a family steeped in “hellfire and brimstone” faith, the folks who strangle nearby innocents with certainty of the right and wrong of everything. Their rigidity frightened me, people who sat so tightly wound in my office I thought they might vaporize. Hisssssssssssssssss!

I’d be seeing the daughter, however, I said to myself. I told them she would be my patient, not they; once I evaluated her and assuming I believed good might be done. I “would not, could not” (as Dr. Seuss says) report back to them; short of imminent risk of self-harm or danger to someone else. They seemed to agree.

She walked in and springtime came with her. A silvery thing, she lit the room, though I cannot explain how. A “presence.” Therapists take in everything or try to.

This young woman was tall, perhaps 5’10” and willowy; black hair against porcelain skin, a pleasant face. Her complexion was so fair I could almost see through her. Someone else had, I suspected, and seen there was no will in her to resist much of anything.

She was not the most expressive person I ever treated, more sadly placid. Not serene, but the kind of calm derived from having the fight drained from you. Almost weary. Her parents had sucked the life out of her. Think vampires. The wind would take her where it chose. Right now she had youth and beauty, but as they say about the short careers in the National Football League (NFL), the three initials really mean “not for long.” Of course, I didn’t understand all this immediately.

Her parents wanted her to follow some “serious,” academic track. She was a dancer. They wanted her earthbound. She wished to leap. Bad combination.

Many of us try to get the love we couldn’t get at home, don’t we, at least for a while? My patient was looking for such affection. Her folks didn’t like her boyfriend: he was not a member of their suburban, uppity class, and worse (to them) freighted with a minority heritage. But before you feel too sympathetic toward him, you must learn more.

I discovered he had introduced her to cocaine, which he also used: a drug, for her, like a key for her internal lock. There she found release, relief, and ecstasy. There, she was no longer anyone’s hostage. But, of course, she’d simply gone from being her parents’ chattel to that of the boyfriend and the drug.

Treatment didn’t go on for long. The job of freeing a person from parental dominance or a lover’s grip must wait if simply getting through the day is difficult. I explored addiction treatment with her. I don’t recall if she began or not, but her interest was only dutiful. Soon enough her parents discovered her use and blamed me for not telling them. Therapy ended.

The character of Alfieri, in Arthur Miller’s A View From the Bridge, says the following:

There are times when you want to spread an alarm, but nothing has happened. I knew, I knew then and there – I could have finished the whole story that afternoon. It wasn’t as though there was a mystery to unravel, I could see every step coming, step after step, like a dark figure walking down a hall toward a certain door. I knew where (she) was heading for, and I knew where (she) was going to end. And I sat here many afternoons asking myself why, being an intelligent man, I was so powerless to stop it. And I even went to a certain old lady in the neighborhood, a very wise old woman, and I told her, and she only nodded and said, ‘Pray for (her) …’

The cynics say counselors are only interested in money, making a fine living off the pain of others. Well, some few are, but most of us want the best for everyone, not just our patients. We are rewarded by human contact and flourishing.

Yes, we cannot help without a therapeutic distance. The invisible boundary doesn’t inoculate us all the time. People we know, in and out of therapy, get inside. It happens to us as to you. We are not sculpted from stone.

Halloween is an odd day to be thinking of prayer, but apt perhaps. This year, when you tuck your candy-buzzed child into bed, and after all your treats have been gobbled up by greedy little monsters, sit back and rest and be grateful if no ghosts haunt you. Then, if you have a picture of this fragile creature because my story was well-told, pray for the (now, no longer young) woman, if she lives.

And for your counselor. This, from an ex-therapist who doesn’t believe in God.

—

The top painting is Marie, by Peder Severin Krøyer. The second image is The Ghost, by Tsukioka Yoshitoshi. Both are sourced from Wikimedia Commons.

42 thoughts on “Patients Who Haunt the Therapist”

Ouch! The client needed help with addiction, but the parents removed her from therapy. I can’t imagine what that feels like to both the therapist and the (presumably underage) client. The therapy hadn’t even had time to really begin, and the client needed some stable, continuous help. I can’t imagine how the therapist – a human being – might naturally wonder about the fate of his former client, and replay the scenario as if to be able to change something. It’s haunting, indeed. It’s sad. And more than one person is affected. I’m so sorry you experienced that, Dr. Stein. I can’t imagine.

Thank you, PP. I have no regrets, no alternative scenario I might have played out to change the outcome. Every therapist with a few miles under his belt has felt the powerlessness I describe here. It is the cost of doing business. We live with it, but it doesn’t feel good. And life goes on.

Did you have hope for her? Do therapists have hope for all their clients especially those whom seem fated towards something unwell? I always ask my therapist if she has hope for me and she always says she does. Sometimes I do. Sometimes I don’t but it’s important for me to believe she does. I just worry that it could be a lie I believe.

I had some hope when we started, Jenn, but I knew we would need time. Part of the dilemma was that she had three levels of dependency to deal with: the drug (which she was in love with), her boyfriend, and her parents. Additionally, she had no will, no anger, no significant accomplishment history (because she was so young), no great intellect, no significant supports outside of those that were unsupportive. As I said, she had her youth and beauty. Time would eventually take the first and the drug might speed up the loss of the second. You, on the other hand, are reading about therapy, writing here, thinking about it. She was not self-reflective. So, I’d say, there is reason to have hope for you. I don’t know about your therapist, but most of us mean well and tell the truth. If we were in the business of selling hope we didn’t believe in, we’d be no better than carnival barkers and a man recently called Daft Twerp by Winston Churchill’s grandson. Hang in there.

Thanks! You just gave me hope! I like your blog. I read it all the time. I think I believe my therapist. After I had been seeing her a while she told me she knew it would take me a while to heal because I couldn’t identify any anger in me and anger in others terrifies me. But taking a while to heal…which it has…I’m still working on it, is not so terrible a road so long as there is hope and help. I think you have a lot of compassion for others. 🙂

I can imagine why memories of this young woman haunt you. You wrote a poignant description of her. Despite the disadvantages surrounding this woman, my hope is that your therapeutic self reached her at some level. However, like you said, you had a sense about her, only witnessing the first few acts of the drama. Yours is a peculiar profession, but a worthwhile one. I will hold the memories of this no longer young woman close to my heart and hope she found peace.

Thank you, J. As I’ve written elsewhere, therapists (and teachers) and among those professions in which the end of the story is infrequently told. Sometimes we hear about it from other patients, friends who were referred by the former client. Sometimes our patients return for a tune-up. And sometimes we get letters of gratitude. The therapist is a bit like the reader of a thrilling novel who discovers that the last chapter has been torn out of the book only after reading everything up to that point. Let’s hope I am wrong about the ghost.

Therapists haunt too….even though I no longer see her, she’s always with me. And I pray for her. This, from an ex-patient who does believe in God. (I love reading your blog, thankyou; it always comes to my inbox on Sunday morning after I’ve been to church. I pray for you too.)

It’s funny because my comment felt so connecting to you as much as a gift to you. I suppose it is either a lesson to learn that thank yous should feel connecting and should be enough or relationships and attachments vary by participant. I have what to think about…

Your story was VERY well told, Dr. Stein. I’ve had a few therapy clients who similarly haunt me. Thank you for telling us about her.
I also love the art work, and the passage from “A View from the Bridge”.

And it’s good for me to know that I’m not alone, in being haunted. I will hold you and this young woman, however old she is now, in my thoughts.
(If “sending good thoughts” is similar to “prayers”, then you have my prayers.)

Thank you Dr. Stein for a beautiful and well told story. I will pray for the young woman although knowing how addiction can kill someone, I wonder if she is still alive. As for her therapist, I will continue to pray for him. I love to read your blogs and think you are truly a man of God even if you do not believe.

It is my understanding that some doctors will want to tell a patient at the very beginning that the Doctor cannot make the patient better. The Doctor will tell the patient that the patient must want to get better and must be willing to work at it and the doctor’s main function is to merely help the patient along with practical advice, etc. Otherwise, no change can occur unless the patient wants to change in the first place and is willing to work at it.
Having heard of this concept, I find it somewhat remarkable that you feel “haunted” by the patient that you describe.
I have written a number of things to you that may have seemed unusual before, and I realize that what I am about to ask may seem downright outlandish, but the following question is inspired at least partially by a hunch.
In regards to the story that you just told: Do you think that it is possible that at least one of the girl’s parents was raised in an orphanage?
I was just thinking, among other things, that being raised in an orphanage might explain in part, the tendency to keep a tight grip on the lives of one’s own children, because of a sense of abandonment from ones own childhood, and the resentment from the implication, at least, that growing up, one was looked upon as a burden to society.
Otherwise, allow me to say that this is indeed a good time of the year to feel haunted for more reasons than one.

Yes, Joseph, therapists do tell their patients they need to drive the change; that treatment is not like surgery, where the patients is unconscious while the doc does his work. I said this often. With respect to the question of being haunted, what you find remarkable will seem less so if you factor in the human equation, make your conception of the treatment process less rational. As to the orphanage question, I can’t rule out some oppressive experience in the lives of these parents. That said, I encountered plenty of people who were raised by their own biological parents, not less or more abusive than someone else’s parents might have been. As you wisely note, therapists encounter lots of “trickle down” of the effects of unfortunate parenting from one generation to the next. Imagine what you might have been like if you had been a slave in any period of history, subject to extreme mistreatment, and then had a child. Would you (or I) been capable of restraining our rage and not taking it out on the little one? Impossible to know. Thanks for the provocative questions, Joseph.

Hi Dr. Stein, Great article. You write so well. You did your best and I am sure your client knows that. I am in contact with many religious leaders. I am Jewish and one of my closet persons I call everyday for support is a retired but stil practicing priest for the cathollic church who is about 80 years old. His Name is Mel Long. He was blessed by pope Paul on a couple of occassions. I have another close friend whom I nick named King James as he is 6’5″ . King James is 38 and his great great grandad on fathers side was Hieber C. Kimbell. Hieber was best friends with Joseph Smith founder of the mormon church. King James always picks up the phone and helps me if anything goes wrong in life. He always helps. Rabbi Marcus a Chabad rabbi in Mission Viejo Calif. seems to also have a strong belief. Of all the people I have met in my entire life only these 3 people really have a belief in God. I think the rest of us play along and try to understand what the concept of god is and maybe try to connect with God. I am 60. I even go the Siek temple some Sundays and help out in the kitchen. I still put the count of real real belivers at 3–King james, Rabbi marcus, and Father Mel Long. My late grandpa Eddie would say “Was you there Charlie?” when people would speak with conviction about what happened 2 or 3 thousand years ago in the bible. Grandpa Eddie escaped the Pogroms in Russia. Thanks for the wonderful article. Steven Turbow 949-857-4820 home phone landline

Thank you, Steve. What a rich array of people! I think it is not often enough that one meets people who live their faith. I’ve known some, entirely my good luck. They are generous, non-judgemental, and act in the world to be helpful at whatever cost to themselves. An extraordinary group, whatever its size. They are to be cherished.

Dr. Stein, thanks for that well written, heartfelt, and haunting real life story. My thoughts for healing go out to that woman wherever she may be today ❤ As a former high school teacher, I'm also haunted by students who lived complicated lives, far beyond my reach to heal.

Sadly, I doubt my former therapist would give me or my well-being a second thought at any time of the year. I, on the other hand, still worry about her. And yes, I do get how dysfunctional that is.

It gives my heart hope that there are more out there just like you. I hope my own current therapist/s turn out to not have the horror-movie ‘surprise!’ element of my first one.

Here’s what I do know, as a serial therapist-mistruster-non-connector: every single one I saw, in an attempt to trust enough to get some work done, moved me one rung further up the ladder. Sometimes two or six or ten, even. They might not have been the one who tamed me enough to get me to stay – I have this image of myself as a feral cat as I am writing this, hissing and spitting at everyone who got too close – but each one gave me enough of something to push me one step closer to domestication. It all added up, and I am finally in a place where I can tolerate getting help and staying, and if I can’t stay, finding my way back.

Maybe, even without the interference of the parents, your client was just utterly unable to stay right then? Maybe you shoved enough saucers of milk out the door for her to try, and try again? If you’d asked any of the therapists I saw after the ‘unhelpful’ one, I think they would have written me off. I’d dead It took 15 years and six of them for me to build the tolerance to be able to stay.

But I took something good from each and every one of them, and I grew and changed as a result. Life changed me, too. I’ll bet most of those half dozen or so therapists would have described me in similar terms – no hope because I was not at all reflective. I don’t know how many would expect me to still be alive.

You just don’t know the good you may have done that spurred her on to the next thing and the one after that and the one after that.

Of course, I hope you are right. This woman arrived early in my therapy career. Had I been smarter and more experienced, I’d have recognized that her parents were not the only problem. She wasn’t the agent driving the therapy. Rather, she was there because they wanted her to be there. My hunch is you decided to get therapy and therefore had more motivation, more frank life in you than this young woman did. And, from your description, you had lots of spunk, energy, which we therapists can put to use in your interest. But, as I say, let’s hope she landed on her feet somehow. Thanks for your encouragement, d.

Yes, here’s to hope. Because surprising and unexpected things happen to, and for, people all the time. I’ll hold her in mind when I’m doing my daily Loving Kindness meditation. And you, too. For being one of the good ones

You sound like a therapist who really does care about his patients. My therapist I’m guessing is a lot like you at least I’m hoping so. I’m new to therapy should and should have came in years ago but I’m here now and beginning to trust and believe he is sincere.
About the girl that you are concerned for. I think you may be too hard on yourself. If you wished you could of handled it perfectly how could you ever grow more for the many others you have helped after her? We tend to always FOCUS on what we should have done instead of what we are now doing.
Put her in a bubble and blow her away. Try to allow other people to help her along her life’s journey …that’s how I learn the most by gleaning from people throughout my life.
And yes I will pray for her but God hears your prayers too 🙂

Not the first time I’ve heard that I’m too hard on myself, Lindy. But, just to reassure all of you who do care, my thoughts about this young woman are not ever present. As I’m sure we’ve all experienced, someone or something (in this case going to a performance of “A View From the Bridge” reminded me of her. Thanks for your prayers, all around.

Greetings Dr G – I will try not to dance off with your blog this time around – to be haunted you are required to be human and in telling us of your haunting Dr G you tell us a story of your humanity, a reminder that I need to keep in the forefront of my scrambled brain – that therapists are not just parking meters that I stuff full of cash allowing me a space to park my battered vehicle of mismatched thoughts and ideas and issues for a certain period of time – the choreography of your dance with this wraith drags onto the stage the inescapable truth that therapists are human in all their perfect imperfections and it is only through their humanness that they can help heal us. And your haunting tells us of the superficiality of outward beauty and our eternal chasing after youth and stilling those busy hands of time. That we are so consumed with the urgent want want want neediness of being acceptable from the outside that we forget about our beauty on the inside. Your wraith was too consumed with hiding within the confines of her addiction, the false promises of her boyfriend and the imperfections of her parents that she was unable to see you standing in front of her in your patient healing humanity. Sometimes we feel safest within our toxic mess or too ashamed to move out of it in case it stains those around us or they see what we have been hiding for ages. We need to believe in our therapists’ humanity in order to move out of our imprisoning judgement of ourselves. Dr G you stand in front of us naked in your vulnerability telling us of your haunting and maybe, between the lines letting us know that from time to time there are failures, that therapists are not these immortal magicians wielding super powers of healing as we expect them to be in our belief that if we tell you what’s wrong you’ll fix it with little to no help from us. Because you are human, and so is my therapist, and within that humanity I find the courage to do the hard work of healing myself. Thanks Dr G, you haunt me in a good way 🙂

Unfortunately, I have seen similar scenarios such as this being played out in our mental health agency, usually a middle-class, over-bearing mother, trying to pressure their uninterested young adult child into receiving treatment from our facility. The mother would be looking for a miracle, and would have high expectations, but when the adult child showed little improvement or decompensated due to not complying with treatment, the mother would cause a ruckus and pull their adult child out of the agency and search for another miracle elsewhere. Since the adult child was on Medicaid, their options were limited. This is an excellent article and one that certainly caused me to pause and reflect.

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In addition to psychology, you'll also find me musing on baseball, classical music, love, friendship, how we live, and how best to live. I'll tell a few stories and draw a few conclusions.
I hope that some tales will touch you and others help you to look at yourself and the world anew. Thanks for reading (and thinking) along with me! Your comments are most welcome.

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